Atrial fibrillation
Most common arrhythmia!
- if onset >48h, rate ctrl is 1st line
- 2nd line = anticoagulate ≥ 3/52 + rate control ⇒ DC cardioversion
rate control strategies
- Beta blockade
- Digoxin
decision to start anticoagulation
stroke risk
- CHADS-VASc
- Offer anticoagulation if female and CHADS-VASc >= 2, or male and CHADS-VASc >= 1.
bleeding risk
ORBIT
- https://www.mdcalc.com/calc/10227/orbit-bleeding-risk-score-atrial-fibrillation
- Higher accuracy than HAS-BLED, NICE 2021 guideliens prefer this over HAS BLED
- Sex → sets Hb/Hct thresholds
- Age >74
- GI bleed, intracranial bleed/haemorrhagic stroke
- GFR <60
- Treatment with antiplatelets
| ORBIT score | Risk group | Bleeds per 100 patient-years |
|---|---|---|
| 0–2 | Low | 2.4 |
| 3 | Medium | 4.7 |
| 4–7 | High | 8.1 |
- HAS-BLED
DVLA rules
- Group 1: stop driving if likely to cause incapacity; once cause is controlled ≥ 4/52, can continue driving
- Group 2: as with Group 1, but 3/12 requirement